5- Homeless Families and Children Abstract

Transcription

5- Homeless Families and Children
Debra J. Rog, PhD, Westat, Rockville, MD
John C. Buckner, PhD, Children's Hospital Boston, Harvard Medical School, Boston, MA
Abstract
Debra Rog and John Buckner report that since the mid-1990s, there has been continued research and
policy interest in understanding the characteristics and needs of families and children who become
homeless, especially in understanding the heterogeneity within the population and whether a “typology”
of families can be created (i.e., distinguishing families with greater needs for services and housing from
those with lesser needs.) The authors review the findings from recent studies on homeless families and
children and summarize the descriptive and outcome findings from evaluations of housing and service
interventions and prevention efforts. With respect to children, research has focused on understanding and
documenting the impact of homelessness on children. Rog and Buckner emphasize that that many of the
challenges homeless families and children confront are also experienced by families that are very poor but
not homeless, pointing to the need for further research on how to target assistance most efficiently to
minimize the incidence and duration of homelessness for low-income families and children in general.
Introduction
The Current Context of Homelessness for Families and Children
Homelessness among families continues to be an all too common occurrence in our nation. Beginning in
the early 1980s, families with young children began to appear at shelters intended for single adults and
quickly became a fast-growing segment of the homeless population. The best estimate is that families
comprise 34 percent of the homeless population (23 percent children and 11 percent adults) on any given
night (Burt et al., 1999). In a given year, this translates to about 420,000 families, including 924,000
children, experiencing homelessness in the United States. By extrapolation, about 1.8 percent of all
families in this country spend at least one night homeless over the course of a year (Urban Institute,
2000). Among just low-income families, about 8 percent of households and 9 percent of children have
been homeless during the past year. It is also believed that many more families are precariously housed,
in doubled-up situations or in substandard housing.
It is important to recognize that there is a structural imbalance creating homelessness that helps to explain
both geographic and temporal differences in rates of homelessness. The nature of the crisis in affordable
2007 National Symposium on Homelessness Research
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for viable solutions. New approaches to service delivery and provision of housing targeted at this population have been developed.
Some of these interventions are becoming widely recognized as “evidence-based.” In the last 5 to 10 years, there has been a
convergence of opinion among advocates and policymakers at all levels of government that chronic homelessness need not exist in
the United States. Momentum around this issue started to build in 2000 when the National Alliance to End Homelessness (NAEH)
released a plan to end homelessness in 10 years. Shortly afterward, Secretary
Homeless Families and Children
housing varies from place to place. For example, the examination of worst case housing needs indicates
that the suburbs experienced the greatest losses in units affordable to extremely low-income families in
the 1990s as a consequence of growth in population and jobs (U.S. Department of Housing and Urban
Development, 2000). Shortages in affordable housing and differences in fair market rents also vary
geographically. Fair market rents, even averaged across entire states, are over twice as high in some states
as in others; local variation is much greater (Pitcoff et al., 2003). In addition, the extent to which public
housing and other housing assistance is available may have a role in explaining this variation. Recent
analyses of the Fragile Families database, which comprises an at-risk sample of families from
communities across the country whose mothers have recently given birth, reveals that among families
living below 50 percent of the poverty level, homelessness is related to having no housing assistance or
having lost that assistance or public housing. Residential stability among those in the poverty sample is
strongly predicted by having or gaining public housing (Rog & Holupka, unpublished). Families living at
the bottom rung of the income ladder have inadequate incomes to pay the fair market rents in literally all
communities. Therefore, the role that the lack of affordable housing plays in creating the structural
backdrop for why homelessness occurs points to its fundamental importance in creating long term
solutions for preventing homelessness among families as well as individuals.
Even within the same locale, the characteristics of homeless families can change over time. Weinreb et al.
(2006) recently compared the characteristics of two samples of similarly enrolled homeless families in
Worcester, Massachusetts, based on studies conducted in the early 1990s and early 2000s. Demographic
characteristics were fairly similar between the two samples. However, compared to the 1993 sample,
homeless families in the 2003 study were poorer (adjusted for the effects of inflation) and reported more
physical health limitations; psychological distress; and mental health disorders, especially major
depression and posttraumatic stress disorder (PTSD). The most noteworthy finding was a fourfold higher
rate of current depression in the 2003 study as compared to the earlier investigation. Reasons for this
increase are unclear and the finding merits replication in other settings to determine whether it is part of a
broader trend.
Recent Research and Evaluation Activity
Since the mid-1990s, there has been continued research and policy interest in understanding the
characteristics and needs of families and their children who become homeless, especially in understanding
the heterogeneity within the population and whether a “typology” of families can be created (i.e.,
distinguishing families with greater needs for services and housing from those with lesser needs). With
respect to children, research has focused largely on understanding the impact of homelessness.
At federal and state levels, there also has been increased attention to the types of housing models needed
by the array of families who become homeless (including transitional, permanent supportive housing, and
permanent housing), the services that are needed to assist families and their children while they are
homeless and after they exit, and strategies for preventing family homelessness and facilitating more
rapid exits.
In this paper, we synthesize what we know in each of these areas, highlighting the relevant research
studies and policy analyses that have been conducted since 1998 that shape our understanding. We begin
with a methodological overview of the more recent research studies on the characteristics and needs of
families and children, followed by a summary of the main findings. We then provide a more in-depth
synthesis of the literature on the characteristics and needs of homeless families overall, and then on the
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impact of homelessness on children. We follow with summaries of the descriptive and outcome findings
from evaluations of various housing and service interventions and efforts to prevent homelessness. The
final section outlines the research that is indicated to fill the gaps in knowledge that remain.
Research on the Characteristics and Needs of Homeless Families and
Children: Summary of the Methodological Context and Key Findings
The body of research on homeless families has grown, though not dramatically, since the mid-1990s.
More has been learned about the size and characteristics of homeless families, especially compared to
equally low-income families who remain domiciled. Several key studies (Shinn et al., 1998; Rog et al.,
1995a; Bassuk et al., 1996) had begun reporting results prior to the 1998 Symposium, though analyses
continued. Two additional large studies were conducted following the Symposium: (1) the National
Survey of Homeless Assistance Providers and Clients (NSHAPC), directed by Burt and colleagues
(1999), which has contributed to our knowledge of basic characteristics of homeless families across the
nation, and (2) analyses of administrative data sets in New York City and Philadelphia by Culhane and
colleagues (1999), which have improved our understanding of families’ use of shelter and the
interconnection of homelessness with involvement in other services and systems.
Several more recent studies that are adding to the literature on the characteristics of families (some with
publications underway or in press) include the evaluation of the five-year CMHS/CSAT Homeless
Families Program (Rog, Rickards et al., in press); a secondary analysis of the Fragile Families and Child
Well-Being dataset (Reichman et al., 2001) focused on comparing families at different levels of
residential instability (Rog et al., 2007); and examinations of housing problems experienced by recipients
of child welfare services (Courtney, McMurtry, & Zinn, 2004; Park et al., 2004).
With respect to homeless children in particular, the first studies were conducted in the mid- to late 1980s,
not long after the issue of homelessness among families became apparent. The findings from these initial
studies helped spawn a second generation of research studies on homeless children that were conducted in
the early to mid-1990s (cf. Bassuk, Weinreb et al, 1997; Buckner & Bassuk, 1997; Buckner et al., 1999;
Buckner, Bassuk, & Weinreb, 2001; Garcia Coll et al., 1998; Masten et al., 1993; Rafferty, Shinn, &
Weitzman, 2004; Rubin et al., 1996; Schteingart et al., 1995; Weinreb et al., 1998; Zeismer, Marcoux, &
Marwell, 1994). These studies were funded by the federal government (e.g., the National Institute of
Mental Health), private foundations, and other agencies. A chief aim of many of these investigations was
to further clarify the impact of homelessness on children. Compared to the earlier studies, these latter
projects enrolled more study participants, included a greater breadth and quality of assessment
instruments, and employed more advanced statistical techniques with which to analyze data.
The studies on homeless families and children have varied in definitions used, study designs, participant
selection, and geographic context, all of which have contributed to differences and inconsistencies among
the studies. In addition, examining and synthesizing the findings of studies over time is confounded by
historical and structural changes in housing, improvements in shelter conditions over time (especially
when examining the effects of homelessness on children), and effects of programs implemented through
the McKinney-Vento Act (such as the educational programs serving as a buffer for children). Few studies
have been longitudinal, only several have used comparison groups of other low-income families to
contextualize the results, and the geographic areas have been limited.
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Despite these limitations, the small body of emergent research has provided insights into the risk factors
associated with family homelessness, the housing and service needs of homeless families and children,
and the impact of homelessness on children. Among the most consistent findings are:
•
The most common profile of a homeless family is one headed by a single woman in her late
20s with approximately two children, one or both under 6 years of age; those at greatest risk
belong to ethnic minority groups.
•
In the Northeast the vast majority of homeless families are headed by single-parent females
(Bassuk et al., 1996), while in other parts of the country there is a greater mix, with a modest
percentage being two-parent families or families headed by a single father (U.S. Conference
of Mayors, 2005).
•
The residential histories of homeless families typically reveal high mobility and instability,
including living in a variety of doubled up and own housing arrangements.
•
Family separations are a common occurrence, both before and after the homelessness
episode.
•
Homeless families are typically extremely poor, and mothers who are homeless lack human
capital—useful skills and abilities—with respect to both education and employment.
•
Conflict, trauma, and violence figure prominently in the lives of homeless families, as they do
with equally poor but domiciled families.
•
The health of mothers who are homeless is often poorer than the health of mothers who are
domiciled, but mothers who are homeless typically report high rates of access to health care;
in contrast, their mental health problems are comparable in rate and nature (e.g., typically
depression) to poor women in general, and are typically unmet.
•
Reports of substance abuse, though likely underestimates, are higher for mothers who are
homeless than for other women in poor families, but lower than for single adults who are
homeless.
•
Both homeless and low-income housed children experience the negative effects of broad
poverty-related adversities. Study findings suggest that although homelessness itself can have
an additional detrimental impact on children’s mental health, physical health, and school
performance, particularly in the short term, the effects tend to dissipate over time once
children are rehoused.
What Have We Learned About Families Who Become Homeless?
Factors That Place Families at Risk of Homelessness
Ethnicity. Homeless families are more likely than poor families, and both are substantially more likely
than the general population, to be members of minority groups, in particular African Americans (Lowin et
al., 2001; Rossi et al., 1987; Susser, Lin, & Conover, 1991; Rog et al, 2007; Rog & Holupka,
unpublished; Whaley, 2002). This is also true of single adults who are homeless. For example, in the
NSHAPC, 62 percent of families and 59 percent of single adults, compared to 24 percent of the general
population, were members of minority groups (Burt et al., 1999). However, the particular minorities
represented vary from city to city. Their race and ethnicity reflect the composition of the city in which
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they reside, with minority groups invariably disproportionately represented (Breakey et al., 1989;
D’Ercole & Struening, 1990; Rog et al., 1995a; Shinn, Knickman, & Weitzman, 1991; Lowin et al.,
2001).
Resources. The incomes of mothers who are homeless are significantly below the federal poverty level
(Bassuk, Buckner et al., 1996, 1997; Rog et al., 1995b; Shinn & Weitzman, 1996). Homeless families’
incomes are slightly higher than homeless single adults’ due to families having greater access to meanstested benefit programs such as TANF and more help from relatives and friends. Nonetheless, homeless
families’ incomes are almost always too low for the families to obtain adequate housing without subsidies
(Burt et al., 1999). In the Worcester Family Research Project (WFRP), a study of 436 homeless and lowincome housed single-parent female-headed families, more than half earned less than $8,000 per year,
placing them at 63 percent of the poverty level for a family of three (Bassuk et al., 1996). Similarly, in the
NSHAPC the median income in 1996 for a homeless family was only $418 per month, or 41 percent of
the poverty line for a family of three (Burt et al., 1999).
In a recent reanalysis of the Fragile Families and Child Well-Being dataset focused on families living at
50 percent or below of the poverty level conducted as part of a larger project designed to inform a
typology of homeless families (Rog et al, 2007), those families who remained residentially stable over
three years without experiencing risk factors for homelessness (e.g., having utilities shut off) were more
likely to have relatively higher incomes and have received housing assistance and to be living with a
partner who was working. Having other adults living in the household appears to increase a mother’s
likelihood of remaining in stable housing.
Findings about the role of social networks of homeless families are mixed. Several studies have found
that mothers in the midst of an episode of homelessness, compared to low-income housed women, have
less available instrumental and emotional support, less frequent contact with network members, and more
conflicted relationships (Bassuk & Rosenberg, 1988; Bassuk et al., 1996; Culhane, Metraux, & Hadley,
2001; Passero, Zax, & Zozus, 1991). One qualitative study found that the lack or withdrawal of support
was a key factor in families becoming homeless (McChesney, 1995), but another study (Goodman, 1991)
found no differences in support between homeless and housed mothers. In contrast Shinn, Knickman, and
Weitzman (1991) found that newly homeless mothers report more recent contact with network members
than low-income housed mothers, and over three-quarters had stayed with network members before
turning to shelter. Moreover, more recent analysis of that dataset (Toohey, Shinn, & Weitzman, 2004)
found that five years later the social networks of the (now) formerly homeless mothers in this sample
were quite similar to those of their housed counterparts. Differences in study findings may be related to
the timing of interviews of the mothers—in the months prior to a homelessness episode, a mother’s
contact with network members may increase, whereas by the time a mother and her children enter shelter,
she may have depleted most of her social network resources.
There is some evidence that conflict in social support networks may be related to poorer symptoms and
outcomes for families. In the WFRP, homeless mothers had smaller social networks that comprised
nonprofessionals and reported more conflicted relationships in their networks than did housed women.
Therefore, large social networks emerged as a protective factor for homelessness, but having a network
marked by interpersonal conflict was a risk factor for homelessness (Bassuk, Buckner et al., 1997).
Conflict with family and friends, especially sibling conflict, was related to impaired mental health
(Bassuk et al., 2002). Similarly, in the recent CMHS/CSAT Homeless Families Program involving
mothers with psychiatric and/or substance abuse issues, mothers reporting conflict in their networks over
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the course of a 15-month follow-up showed less improvement in a number of outcomes—including
mental health symptoms and functioning, trauma, and substance abuse, regardless of the type of
intervention they received (Rog, Buckner et al., in press; Sacks et al., in press; Pearson et al., in press).
Young Children and Pregnancy. Not only are homeless families overwhelmingly headed by women,
but they are disproportionately families with young (pre-school) children. The risk for homelessness is
highest—and higher than the general population rate—among families with children under the age of six.
Furthermore, the risk increases for younger children, with the highest rate of risk among families with
children under the age of one year (“infants”), as approximately 4.2 percent of infants were homeless in
1995 (Culhane & Metraux, 1999). Having young children may place parents at a competitive
disadvantage in terms of holding a job and being able to afford housing.
Pregnancy itself is a risk factor for homelessness (Shinn et al., 1998). In a comparison of homeless public
assistance families in New York with a sample of housed families on public assistance, 35 percent of the
homeless women were pregnant at the time of the study and 26 percent had given birth in the past year,
while only 6 percent of the housed group were pregnant and 11 percent had given birth recently
(Weitzman, 1989).
Other Needs and Problems Facing Homeless Families
Family separations and influence on family composition. In recent years, the extent to which families
experience the temporary or permanent separation from a child when homeless or at various stages in
their residential history has become more apparent (Cowal et al., 2002; Hoffman & Rosencheck, 2001).
Parent-child separation among homeless families is part of a much broader issue. Because residents of
family shelters must include at least one parent and at least one child, parents who are separated from
their only child or all of their children are not welcome at family shelters and instead must find shelter in
facilities meant for “single” adults. The NSHAPC reported that 60 percent of all homeless women in 1996
had children younger than 18 years, but only 65 percent of those women lived with any of their children
(and often not all of their children); similarly, 41 percent of all homeless men had minor children, yet only
7 percent lived with any of them (Burt et al., 1999). Other studies yield similar findings (Cowal et al.,
2002; Maza & Hall, 1988; North & Smith, 1993; Rossi, 1989; Zima et al., 1996). The residents of shelters
intended for single adults include some individuals who would be in a family shelter if they were
presently caring for their child(ren). This is borne out in a study conducted in Alameda County, California
by Zlotnick, Robertson, and Wright (1999), who interviewed 171 homeless women drawn from a
countywide probability sample. Of these women, 84 percent were mothers and 62 percent of these
homeless mothers had a child under the age of 18 living either in foster care or some other out-of-home
placement.
Among families with children, parent-child separation is sometimes the choice made by a parent, usually
the mother, in deciding the best interests of a child; at other times, it can be a decision forced upon her by
the child welfare system, shelter staff, or relatives (Cowal et al., 2002; Park et al., 2004). Cowal et al.
(2002) conducted the most comprehensive investigation to date on this issue. Their study, conducted in
New York City during the early 1990s, involved 543 low-income families, 251 of which had experienced
homelessness at some point in the five prior years. They found that 44 percent of the homeless families
had experienced a child separation, compared to only 8 percent of low-income never homeless families.
Even when accounting for histories of mental health and substance abuse problems as well as domestic
violence (directed at the mother), homelessness was strongly associated with a family experiencing such a
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separation (Cowal et al., 2002). The reasons why the risk of parent-child separation increases when a
family becomes homeless is not entirely clear, but it is likely due to multiple factors. The “fishbowl
hypothesis” posits that parenting practices are under closer scrutiny when a family is in a shelter than
when housed, posing a risk for child welfare placement (Park et al., 2004). Alternatively, in some cases, a
soon-to-be-homeless mother will ask that a relative care for her child so that the child can continue
attending the same school. In other instances, shelters may not allow adolescents, especially males, to stay
in their shelter, thereby forcing a family-child separation.
Homelessness is not only a major factor in family separations; it also makes the reunification of separated
families more difficult. Cowal and colleagues (2002) found that only a subset (23 percent) of the
separated children were living with their mothers at the five-year follow-up (Cowal et al., 2002). In most
studies, the majority of separated children lived with relatives, but a substantial minority were in foster
care or had Child Protective Service (CPS) involvement (26 percent, Cowal et al., 2002; 6 percent,
DiBlasio & Belcher, 1992; 15 percent, Zlotnick, Robertson, & Wright, 1999). In a five-year follow-up of
a birth cohort of children in Philadelphia, being in a family that requested shelter was strongly related to
CPS involvement and to foster care placement (Culhane et al., 2003). The risk for CPS involvement
increased as the number of children in a family increased. Similarly, in another Philadelphia study there
was a greater risk for child welfare involvement for those families with longer shelter stays, repeated
homelessness, and with fewer adults in the family (Park et al., 2004).
The link between child homelessness and foster care is even more disturbing in light of the preponderance
of research that has found childhood separation—and especially foster care involvement—to be a
predictor of homelessness in adults (Bassuk, Buckner et al., 1997; Bassuk, Rubin, & Lauriat, 1986;
Knickman & Weitzman, 1989; Susser, Lin, & Conover, 1991; Susser, Conover, & Struening, 1987) as
well as future separation from one’s own children (Nunez, 1993).
Human capital: Education, employment, and income. Adults in both homeless and other poor families
generally have low levels of educational attainment and minimal work histories. Compared to the national
average of 75 percent of adults having a high school diploma or GED, for example, high school
graduation or GED rates for mothers in homeless families range from 35 percent to 61 percent across a
number of studies (Bassuk et al., 1996; Burt et al., 1999; Lowin et al., 2001; Rog et al., 1995b; Rog,
Rickards et al., in press; Shinn & Weitzman, 1996). Overall, the rates of educational attainment for
homeless families are lower than for homeless single adults (47 percent versus 63 percent in the
NSHAPC) (Burt et al., 1999) but similar to other low-income families.
Not surprisingly, most homeless mothers (84–99 percent) upon entry into shelter are not working (Bassuk
et al., 1996; Lowin et al., 2001; Rog et al., 1995b; Rog, Rickards et al., in press.) The majority of
homeless mothers have had some work experience, however, ranging from 67 percent in the Worcester
study (Brooks & Buckner, 1996) to over 90 percent in the RWJF/HUD Homeless Families Program and
the recent CMHS/CSAT Homeless Families Program (Rog et al., 1995b; Rog, Rickards et al., in press).
Among homeless and housed low-income mothers in the Worcester study, becoming pregnant before the
age of 18 significantly lowered a woman’s chances of having been employed (Brooks & Buckner, 1996).
Partner violence and childhood abuse. Homeless mothers, like poor women in general, have
experienced high rates of both domestic and community violence (Bassuk et al., 1996; Bassuk, Perloff, &
Dawson, 2001; Browne & Bassuk, 1997). Many women report having been both victims and witnesses of
violence over their lifetimes. In the WFRP, almost two-thirds of the homeless mothers had been severely
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physically assaulted by an intimate partner and one-third had a current or recent abusive partner (Browne
& Bassuk, 1997). More than one-fourth of the mothers reported having needed or received medical
treatment because of these attacks (Bassuk et al., 1996). Supporting these findings, Rog and her
colleagues (1995b) reported that almost two-thirds of their nine-city sample of homeless women
described one or more severe acts of violence by a current or former intimate partner. Not surprisingly,
many of these women reportedly lost or left their last homes because of domestic violence.
In addition to adult violent victimization, many homeless mothers experienced severe abuse and assault in
childhood. The WFRP documented that more than 40 percent of homeless mothers had been sexually
molested by the age of 12 (Bassuk et al., 1996). Women participating in the CMHS/CSAT study reported
similar findings, with 44 percent reporting sexual molestation by a family member or someone they knew
before the age of 18 (Sacks et al., in press). Sixty-six percent of the women in the WFRP experienced
severe physical abuse, mainly at the hand of an adult caretaker. Other studies have found similar results
(e.g., Rog, Rickards et al., 1995b; Sacks et al., in press; Rog et al., in press).
Health and dental needs. Homeless mothers and their families face a number of health challenges and
problems, some that may stem from homelessness and others that may have contributed to becoming
homeless. Mothers who are homeless, for instance, have more acute and chronic health problems than the
general population of females under 45 years of age. Bassuk et al. (1996), for example, found that 22
percent of the mothers reported having chronic asthma (more than four times the general population rate),
20 percent chronic anemia (ten times the general population rate), and 4 percent chronic ulcers (four times
the general rate). These rates among homeless mothers in Worcester were comparable to those found in a
comparison group of low-income housed, never homeless mothers (Bassuk et al., 1996).
In the RWJF/HUD Homeless Families Program (Rog et al., 1995b), 26 percent of the mothers reported
having two or more health problems in the past year, and 31 percent characterized their health as poor or
fair. Likewise, in the more recent CMHS/CSAT Homeless Families study, 44 percent of the women
reported their health as being only fair, poor, or very poor when they entered the study, and 43 percent
indicated that they had needed some sort of medical services in the prior three-month period (Rog,
Rickards et al., in press; Rog, 2004). Despite the reported poor health, in both of these studies most
women report having had some access to health services while homeless: 75 percent in the RWJ
Homeless Families Program, typically through Medicaid (Rog et al., 1995b), and 81 percent in the
CMHS/CSAT Homeless Families Project (Rog, 2004).
A significant unmet health need among homeless families is dental services. The RWJF/HUD Homeless
Families program found that 62 percent of the families needed dental services at baseline, while only 30
percent reported receiving services prior to entering the program (Rog & Gutman, 1997). Similarly, in the
more recent CMHS/CSAT Homeless Families project, 44 percent of the families reported needing dental
services at baseline, and only 28 percent of these families reported receiving dental services in the three
months before entering the program (Rog, 2004).
Substance abuse and mental health. Studies differ on overall prevalence of substance abuse and
mental health problems among mothers who are homeless and the extent to which these problems may
function as risk factors, largely due to how they are defined and measured (including both the actual
measure and the time period being assessed) (Shinn & Bassuk, 2004). Whatever the measurement, it is
clear that the nature of the problems is far different than for single adults who are homeless.
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Data from the WFRP indicates that homeless families are more likely than other low-income families, but
less likely than individuals who are homeless, to report abusing substances (Bassuk, Buckner et al., 1997;
Burt et al., 1999). Rates of reported lifetime use of substances range from 41 percent (Bassuk et al., 1996)
to 50 percent (Rog et al., 1995b). Rates are much lower for current use as exemplified by a reported illicit
drug use of 5 percent in the WFRP (Bassuk et al., 1996) and a 12 percent rate of illicit drug use in the past
year in the Rog et al. 1995b study. Heavy use of alcohol or heroin over the prior two years was found to
be a risk factor for homelessness in the WFRP (Bassuk, Buckner et al., 1997). Similarly, recent reanalyses
from the Fragile Families dataset (involving low-income mothers who have recently given birth) suggest
that substance abuse is a risk factor for homelessness, with families who report experiencing recent
homelessness having higher rates of substance use than families who remain stably housed (Rog &
Holupka, unpublished).
Depression among mothers who are homeless is relatively common, as it is for low-income women
generally, while psychotic disorders are rare (Bassuk et al., 1998; Shinn and Bassuk, 2004). In the
reanalysis of the Fragile Families data, reports of mental health issues were related to becoming homeless
and their absence related to stability (Rog et al., 2007). Forty-six percent of families experiencing
homelessness in Year 1 of the study reported feeling sad or depressed two or more weeks in a row,
compared to 12 percent of the families who remained stably housed during that time. Comparable
percentages were found at the Year 3 follow-up.
Given the high levels of stress and the pervasiveness of violence, it is not surprising that mothers who are
homeless have high lifetime rates of posttraumatic stress disorder (PTSD) (3 times more than the general
female population), major depressive disorder (2.5 times more than the general female population) and
substance use disorders (2.5 times more than the general female population) (Bassuk et al., 1998). Bassuk
and colleagues (1996, 1998) found, however, few differences between homeless and low-income housed
mothers. Thirty-six percent of homeless mothers and 34 percent of low-income housed mothers had
lifetime prevalence of PTSD and 18 percent of homeless mothers compared to 16 percent of low-income
housed mothers reported current PTSD.
In addition, between one-quarter and one-third of mothers who are homeless report at least one lifetime
suicide attempt (Bassuk et al., 1996; Rog et al., 1995b). In fact, Rog and Gutman (1997) reported that a
majority of the mental health hospitalizations reported by women in the RWJF/HUD nine-city evaluation
were related to suicide attempts.
Finally, it is important to recognize that many women who are homeless face multiple problems and
issues. In the WFRP, the most common current co-occurring disorders found were major depression,
substance use disorders, anxiety disorder, and PTSD (Bassuk et al., 1998; Shinn & Bassuk, 2004). In
addition, Rog and her colleagues (1995b) noted that 80 percent of the homeless women had current needs
in at least two of three areas examined: human capital (poor education or lack of a job), health, and
mental health (including substance abuse and trauma-related issues). One-quarter of the women had
issues in all three areas.
Residential instability. Family homelessness is perhaps most aptly described as a pattern of residential
instability. Homeless episodes are typically part of a longer period of residential instability marked by
frequent moves, short stays in one’s own housing, and doubling up with relatives and friends. As an
illustration, in the 18 months prior to entering a housing program for homeless families in nine cities,
families moved an average of five times, spending 7 months in their own place, 5 months literally
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homeless or in transitional housing, 5 months doubled up, and 1 month in other arrangements. Overall,
one-half (53 percent) had been homeless in the past. It is important to note, however, that this sample of
families was not random, but consisted of families selected for a variety of service needs, with prior
homelessness a selection criterion at some of the study sites (Rog & Gutman, 1997).
Other studies document the lack of stability that the families experience both before and after
experiencing homelessness. For instance, Shinn and colleagues (1988) documented that many families on
the precipice of homelessness for the first time had never established themselves in stable permanent
housing. Before entering shelter, doubling up with other families was common as were moves from one
overcrowded living arrangement to another. At-risk families who had been able to obtain a housing
subsidy were much more residentially stable and less likely to enter shelter. In a more recent study of
newly homeless families in eight sites across the country who were screened as having mental health
and/or substance abuse problems, the families spent less than one-half of the prior six months in their own
homes (Rog, 2004). Staying with relatives or friends is often found to be the most common living
situation prior to entering shelter (Lowin et al., 2001; Rog, 2004). The length of time families stay
homeless is a function, in part, of shelter limits on stay and the availability of affordable housing.
Families with limited incomes have few housing choices. As discussed later in this paper, there is
substantial evidence that subsidized housing plays a major role in reducing homeless stays and in ending
homelessness for a majority of families.
To date, there have not been any conceptual models developed, or research conducted, that help to
explain the manner in which risk and protective factors for homelessness among families interrelate.
Presumably, there is a class of distal as well as a class of proximal mediating variables that can be
delineated in efforts to explain pathways into homelessness. Distal variables for a homeless mother could
include history of childhood abuse, foster care placement, and other disruptive experiences early in life.
These distal factors could affect mediating variables such as recent substance abuse, mental health issues,
and conflict within the social network, which in turn play roles in affecting a person’s vulnerability to
becoming homeless. In addition, recent research (Rog & Holupka, unpublished) suggests that the absence
of protective factors (e.g., having housing assistance, having another adult living in a household)
combined with having mental health and substance abuse concerns makes it difficult for vulnerable
families to stay residentially stable and heightens their risk of homelessness.
What is the Toll of Homelessness on Children Living With Their
Families?
The year 1987 marked the beginning of published studies that focused on homeless children living with
their families. Four years later, a sufficient amount of research had been conducted to warrant a review
article by Rafferty and Shinn (1991). This “first generation” of research on homeless children called
attention to a growing number of youngsters who were living in shelters and clearly at risk for developing
problems. Unlike the studies of families that sought to understand what placed certain families at greater
risk of homelessness, the focus of these studies was to determine the impact of homelessness on children.
The early investigations documented demonstrable problems that children were having in various areas of
functioning, such as health, developmental status, mental health and behavior, and academic performance
(cf. Alperstein, Rappaport, & Flanigan, 1988; Bassuk & Rubin, 1987; Miller & Lin, 1988; Rescorla,
Parker, & Stolley, 1991; Wood et al., 1990).
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As noted earlier, the findings from these initial studies helped spawn a second generation of studies on
homeless children, funded by a variety of public and private sources, conducted in the early to mid-1990s
(cf. Bassuk, Weinreb et al., 1997; Buckner & Bassuk, 1997; Buckner et al., 1999; Buckner, Bassuk, &
Weinreb, 2001; Garcia Coll et al., 1998; Masten et al., 1993; Rafferty, Shinn, & Weitzman, 2004; Rubin
et al., 1996; Schteingart et al., 1995; Weinreb et al., 1998; Zeismer, Marcoux, & Marwell, 1994). As a
group, these studies were stronger due to greater sample sizes and improved methodology. Again, their
dominant focus was to further an understanding of the impact of homelessness on various dimensions of
child functioning.
This second wave of studies on homeless children did not generate as clear a pattern of results as the first
set of investigations. The most consistent and uniform finding across these studies was the detection of
elevated problems among both homeless and low-income housed children compared to children in the
general population (using normative data). This appears to be due to the effects of poverty-related risk
factors that low-income children, whether currently homeless or in housing, have in common. What was
not consistently found across this second wave of studies was an additional elevation in problems among
homeless children in comparison to low-income housed children. In other words, these latter studies
seldom found negative effects in children that could be attributable to the experience of homelessness, per
se.
Impact on mental health and behavior. At least seven publications since 1993 have examined the
impact of homelessness on the mental health and behavior of children. Of these studies, Masten et al.
(1993) in Minneapolis, Ziesemer et al. (1994) in Madison, Wisconsin, and Schteingart et al. (1994) in
New York City reported no differences between homeless study participants and their low-income housed
counterparts on various indices of mental health, principally the Child Behavior Check List (CBCL) and
the Children’s Depression Inventory.
In the WFRP, Bassuk, Weinreb et al. (1997) found that homeless preschool-age children had higher
elevated “externalizing” problem behaviors (e.g., aggressive behavior) as measured by the CBCL than
low-income housed children, but did not find significant differences on the “internalizing” (e.g.,
depressive, anxious, and withdrawn behavior) subscale. Conversely, Buckner et al. (1999) found the
opposite among school-age children in the Worcester study (significantly worse scores for homeless
children on the internalizing subscale of the CBCL but not on the externalizing subscale). Assessing
mental health problems in a diagnostic manner using DSM-III-R criteria, Buckner and Bassuk (1997)
found that homeless and low-income children age 8 years and older in the Worcester study had nearly
identical current prevalence rates for psychiatric disorders (about 32 percent), a rate much higher than the
19 percent prevalence found among children in the general population (Shaffer et al., 1996). So, while
these second-generation studies of homeless children documented a poverty-related effect on children’s
mental health/behavior (i.e., data on low-income children, whether homeless or housed, looked worse
than normative data), effects due specifically to homelessness-related factors were much harder to detect.
Impact on education-related problems. There has been a somewhat more consistent pattern of findings
across studies in the realm of education-related problems and outcomes. When the crisis of family
homelessness emerged in the 1980s, most school systems were unprepared to deal with the complex
needs of homeless children. Many homeless children were denied access to education, with school
districts claiming that families living in shelter did not meet permanent residency requirements and
therefore were not eligible for enrollment (Rafferty, 1995). Other impediments to school attendance
included immunization requirements, availability of records, and transportation to and from school
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(Stronge, 1992). If homelessness causes children to miss school, such absence will likely be detrimental
to their academic performance. As part of the Stewart B. McKinney Homelessness Assistance Act, which
Congress passed in 1987, the Education of Homeless Children and Youth (EHCY) program was
established to ensure that homeless children had the same access to public education as other children.
Studies of homeless children conducted prior to and shortly after the creation of the EHCY program have
consistently documented disrupted school attendance and academic underperformance (Bassuk & Rubin,
1987; Masten et al., 1993; Masten et al., 1997; Rafferty, Shinn, & Weitzman, 2004; Rubin et al., 1996;
Zima, Wells, & Freeman, 1994). Since then, the EHCY program has provided formula grants to state
educational agencies to review and revise policies that may act as barriers to school enrollment and
attendance in addition to funding direct services such as transportation and tutoring.
Anderson, Janger, and Panton (1995) conducted a national evaluation of the EHCY program and found
that over 85 percent of homeless children and youth were regularly attending school, indicating a marked
improvement in school access compared to pre-EHCY program attendance rates. Similarly, Buckner,
Bassuk, and Weinreb (2001) found no evidence of higher school absenteeism or lower academic
achievement scores among homeless school-age children in the Worcester study as compared to lowincome housed children. Children in each group had missed an average of six days of school in the past
year and scores on a composite measure of academic achievement were identical for both groups. Rates
of school suspension, grade retention, and special classroom placement were actually higher in the housed
comparison group. This lack of differences in the Worcester study on school- and education-related
variables suggests that the EHCY program has been successfully implemented in that city, as evidenced
by similar absenteeism rates between the homeless and housed school-age children. What this study
illustrates is that the ability of researchers to detect an effect of homelessness on children may depend in
part on the historical context; that is, the timing of the study in relation to the societal response that has
arisen to address the problem.
Impact on development. This inconsistency in study results concerning the impact of homelessness
extends to findings on the cognitive and motor development of young homeless children. Two of the three
studies that have addressed this domain are first-generation studies and the third, a second-generation
project. The first two studies (Wood et al., 1990: Bassuk & Rosenberg, 1990) found a greater proportion
of developmental delays among the homeless preschool children than comparison groups of low-income
housed children. Both used the Denver Developmental Screening Test, an instrument that focuses on
reports about the child by a parent or guardian. The third study (Garcia Coll et al., 1998) employed the
“gold standard” measure of developmental status in infants and young children, the Bayley Scales of
Infant Development, which involves direct observation and interaction with a child by a tester who has
undergone specialized training. In contrast to the earlier two studies, Garcia Coll et al. found no
differences in developmental status between homeless and low-income housed infants/toddlers on the
Bayley. Moreover, scores on the Vineland Screener (a measure of adaptive behavior that asks a parent
about a child’s communication, daily living, socialization and motor skills) were almost identical between
the two groups.
Impact on health. The studies of Alperstein, Rappaport, and Flanigan (1988) in New York City and
Miller and Lin (1988) and Wood et al. (1990) in Los Angeles represent the earliest studies of homeless
children that assessed health outcomes. Each of these investigations found a higher prevalence of healthrelated problems compared to low-income housed children or children in the general population. A
second-generation study (Weinreb et al., 1998) with more methodological rigor than prior studies
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compared 293 homeless children ranging from 2 months to 17 years of age to 334 low-income housed
(never homeless) children and also found greater frequency of health problems among homeless children.
Only one study, Menke and Wagner (1997), did not show differences on health-related outcomes between
homeless and low-income housed groups of children.
Summary of impact of homelessness. Past studies have been somewhat mixed in their findings on the
impact of homelessness on children, especially when comparing homeless to low-income housed
children. While the magnitude of severity of problems found among homeless (and low-income housed)
children tends to be in the mild to moderate range in the short term, in virtually all instances these two
groups of low-income children look worse on various outcome measures compared to children in the
general population. Very little research has gauged the impact of homelessness over the longer term, but
the evidence suggests that any short-term impact dissipates after several years. A two year follow-up of
homeless children in the WFRP indicated that exposure to violence had a much more pronounced
negative effect on school-age children’s mental health than did history of homelessness (Buckner,
Beardslee, & Bassuk, 2004). Similarly, Shinn et al. (in press) found, across a broad age range, that
formerly homeless and housed children in New York City looked quite similar to each other on indices of
health, mental health, IQ, and academic achievement approximately 55 months after the initial shelter
entry of the homeless group. These investigators, however, did find elevated internalizing and
externalizing behavior problems at follow-up among a subgroup of children who were homeless when
they were infants and toddlers as compared to their housed counterparts.
Due to the lack of consistency across the studies that have been conducted, all that can be reasonably
concluded from the scientific evidence at this stage is that homelessness (when meant as a stay in a family
shelter) can have a detrimental short-term impact on children, but not in all instances. Homelessness can
function as a “marker of risk” for children, meaning that children who are homeless are likely going to
have a higher prevalence rate of problems than similar age youths in the general population, but not
necessarily higher against a comparison of similarly poor, but housed children.
Differences among the studies from the first to second generation also suggest that some of the
improvement in children’s outcomes may be due to the much greater societal response to the problem of
homelessness than was the case when the earliest studies were undertaken. The McKinney-Vento Act
programs and improvements to family shelters have likely buffered some of the negative impact of
homelessness.
In addition, the structural backdrop of homelessness, as noted, likely complicates what can be attributed
to the impact of homelessness on children. Because homelessness among families is largely due to a
structural imbalance between the supply and the demand for affordable housing, those most vulnerable to
homelessness are those least able to compete for the scarce supply of available affordable housing
(Buckner, 1991, 2004a; Shinn, 1992). In the beginning stages of a protracted housing shortage, it is likely
that the most vulnerable families will become homeless first—those with significant problems or issues
such as a mental health, substance use, or physical health disorder. As a structural problem worsens over
time regarding the demand for affordable housing in relation to the supply, studies of homeless families
would likely find differences in rates of problems between homeless and low-income housed families
compared to findings of investigations conducted in the early stages of a tightening housing market. The
implication this has for homelessness research is that, all other things being equal, in a gradually
worsening housing market that takes many years to unfold, early studies may reveal greater problems
among shelter residents (adults and children) than do later studies. In addition, if there are other factors
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that determine which families entered shelter, these also could have a role in influencing children’s
mental health (or other aspects of child functioning). As a result, the status of being homeless, itself, may
not be the reason or only reason for the heightened problems seen among children living in shelter.
Researchers who have examined the impact of homelessness on children have also had to grapple with the
difficulty of trying to demarcate where the effects on children of poverty-related sources of risk end and
homelessness-specific risks begin. Children from low-income families, whether homeless or housed, face
an array of chronic strains (e.g., hunger, feeling unsafe) and acute negative life events (e.g., exposure to
community and domestic violence) that stem from the broader conditions of poverty. In terms of exposure
to such risk factors, homeless and low-income housed children differ far more from children in the
general population than they do from one another. Despite their current housing status being dissimilar,
homeless children and low-income housed children have many more similarities than differences in terms
of the extent and nature of adversities to which they have been exposed (cf. Masten et al., 1993; Buckner
et al., 1999). Even regarding housing status, it is important to note that homelessness is a temporary state
through which people pass, not a permanent trait emanating from individual deficits (Shinn, 1997).
Moreover, housed low-income children can often be found living in rundown and decrepit dwellings,
thereby reducing the contrast between them and children living in shelter. When viewed in the context of
a much broader range of adversities, it is apparent that homelessness is but one of many stressors that
children living in poverty all too frequently encounter.
Ending Homelessness for Families: Evaluations of Different Housing
Approaches
The research directly focused on housing interventions for homeless families has been largely limited to
several descriptive evaluations, including evaluations of:
•
housing and supports for families with histories of homelessness and other difficulties, such
as the nine-city RWJF/HUD demonstration of services-enriched housing (Hambrick & Rog,
2000; Rog & Gutman, 1997; Rog et al., 1995a, 1995b), the Minnesota Supportive Housing
and Managed Care Pilot (National Center on Family Homelessness, 2006, 2004a, 2004b), and
the Charles and Helen Schwab Foundation Family Supportive Housing Initiative (Nolan,
Magee, & Burt, 2004; Nolan et al., 2005);
•
rapid housing programs for first-time or at-risk homeless families, including the Charles and
Helen Schwab Foundation’s Housing First Collaborative (LaFrance Associates, 2005); and
•
transitional housing, including a descriptive review of a sample of transitional housing
programs across the country (Burt, 2006) and an evaluation of the Gates Foundation’s Sound
Families Initiative (Northwest Institute for Children and Families, 2005).
In addition, findings that inform our understanding of how to improve the residential stability of families
have emerged from longitudinal studies that examine factors related to increased stability. In this section,
we highlight the main findings that emerge from these evaluations and research efforts.
The Role of Subsidies
Increasing the affordability of housing by affecting the supply and cost of housing or increasing
disposable income by increasing wages or subsidizing costs of housing, childcare, food, and other
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essentials would likely prevent homelessness among low-income families as well as end it for the
majority who enter shelters. The findings of studies conducted during the 1990s with respect to the role of
subsidies and affordable housing in ending family homelessness provide undeniable evidence for the role
these supports can play.
In the WFRP, Bassuk, Buckner et al. (1997) found that, controlling for other explanatory variables, cash
assistance in the form of AFDC and housing subsidies in the form of Section 8 vouchers or certificates
were important protective factors. Ninety-three percent of low-income housed families had received cash
assistance in the past year as compared to 72 percent of homeless families in the year prior to their
homeless episode. For housing subsidies, these respective figures were 27 percent and 10 percent.
Other studies have indicated that the strongest predictor of exits out of homelessness for families is
subsidized housing (Shinn et al., 1998; Zlotnick, Robertson, & Lahiff, 1999). In a longitudinal study of
first-time homeless families and a comparison random sample of families on public assistance, residential
stability five years after initial shelter entry was predicted only by receipt of subsidized housing (Shinn et
al., 1998). Eighty percent of the formerly homeless families who received subsidized housing were stable
(i.e., in their own apartment without a move for at least 12 months), compared to only 18 percent who did
not receive subsidized housing (Shinn et al., 1998). Additional studies have found that families receiving
subsidized housing upon discharge from shelter are less likely to return to shelter than families receiving
some other type of placement (Stretch & Krueger, 1992; Wong, Culhane, & Kuhn, 1997). Similarly, after
a policy of placing homeless families in subsidized housing was adopted in Philadelphia, the number of
families entering shelter who previously had been in shelter dropped from 50 percent in 1987 to less than
10 percent in 1990 (Culhane, 1992).
Demonstration initiatives studying supportive housing with different intensities of services also found
high stability rates, regardless of the intensity of the services received. In the nine-city RWJF/HUD study
in which homeless families received both Section 8 certificates and various intensities of case
management services across the nine sites, 88 percent of the families accessed and remained in permanent
housing for up to 18 months (based on 601 families in six sites where follow-up data were available)
(Rog & Gutman, 1997). This finding was replicated in a 31-site study of families in the Family
Unification Program who received Section 8 certificates and child welfare services. Eighty-five percent or
more of the families in each site were still housed after 12 months, despite different eligibility criteria and
services across the sites, among other differences (Rog, Gilbert-Mongelli, and Lundy, 1998). Weitzman
and Berry (1994), in a smaller study in New York City in the early 1990s, examined an intervention very
similar to the RWJF/HUD intervention, involving subsidized housing coupled with short-term intensive
case management compared to a group that received subsidized housing but no special services. At the
end of a one-year follow-up period, the vast majority of families in both groups were housed, and less
then 5 percent had returned to shelter. The type of subsidized housing received was the strongest single
predictor of who would return to shelter, with families in buildings operated by the public housing
authority more stable than those in an alternative city program (Weitzman & Berry, 1994).
The evaluation of the Welfare to Work Voucher Program (HUD, 2004; 2006) provides additional
evidence for the effects of tenant-based rental assistance on self-sufficiency. Although the program is not
specifically targeted to homeless families, it is targeted to families living on welfare who have a similar
demographic profile. The study found that the program resulted in small but significant improvements in
the quality of neighborhoods where people lived and that the vouchers greatly reduced a family’s
probability of becoming unstably housed or homeless.
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Finally, examinations of transitional housing suggest that subsidies play an important role in successful
transitions for many families. The preliminary evaluation of the Sound Families Initiative in the greater
Seattle area indicated that 70 percent of families exiting did so with a Section 8 voucher (Northwest
Institute for Children and Families, 2005). Moreover, the report concluded that nearly all families needed
some type of housing subsidy to secure permanent housing, and in some cases families needed to stay in
the transitional housing longer when there were reductions in voucher availability. In a review of 53
transitional housing programs across five communities, Burt (2006) found that, on average, 35 percent of
those leaving transitional housing left with a subsidy (about half of those going into permanent housing).
The percentage ranged by community, with the highest percentage being in Seattle/King County,
coinciding with the Sound Families evaluation findings (Northwest Institute for Children and Families,
2005).
Although housing subsidies appear to be a critical resource for exiting or preventing homelessness, a
small percentage of families go back to shelters after receiving subsidized housing. In the New York City
follow-up study, 15 percent of 114 families who obtained housing subsidies returned to shelters at some
point during the five-year follow-up period (Stojanovic et al., 1999); in the RWJF/HUD nine-site
evaluation, 11 percent of the families entering shelter had previously received a subsidy. In the New York
City study, reasons for leaving subsidized housing included serious building problems—safety issues,
rats, fire or other disaster; condemnation; or the building’s failure to pass the Section 8 inspection. In the
RWJF/HUD study, informal discussions with city officials suggested that families may return to shelter
because of failure to renew Section 8 certificates for a variety of reasons.
Need for More Information on Matching Interventions with Need
There have been no studies that compare the effectiveness of different types of housing approaches—
transitional housing, permanent supportive housing, or permanent housing—for homeless families. The
descriptive studies conducted to date focus on one approach and universally note the importance of
affordability in housing. Almost all evaluations also describe the variability of implementation of the
housing model. For example, as Burt (2006) notes, there is no standard model of transitional housing—
the programs vary greatly with respect to who is served, services provided, the configuration of the
housing, and the length of the programs, among other variables. Similarly, Rog and colleagues (1995a)
found that even in a demonstration program that stipulated a services-enriched housing model, there was
great variation among and within service sites as to the intensity of the case management provided. To
date, there have been no studies examining the type of housing and service mix best suited to families
with different needs. There have been no comparative studies of models, or studies that systematically
varied the intensity of services. What does exist are descriptive evaluations of different housing models
for specific subgroups of families, generally families with prior episodes of homelessness and other needs
who may need supports. The most recent and current evaluations are described below.
The Minnesota Supportive Housing and Managed Care Pilot, a demonstration project funded by the state
of Minnesota and administered by the Hearth Foundation, serves single adults and families with histories
of homelessness exacerbated by other difficulties. The housing provides a range of supports to those
living in the subsidized housing. A multi-pronged evaluation is being conducted by the National Center
on Family Homelessness, and includes a multi-year qualitative study, a cost study, an adult outcome
study, and a study on the children in the families. Preliminary data indicate dramatic increases in days
spent in their own housing despite struggles with deep-seated problems (National Center on Family
Homelessness, 2006, 2004b).
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Similarly, in a descriptive evaluation of the Family Permanent Supportive Housing Initiative funded by
the Charles and Helen Schwab Foundation (Nolan et al., 2005; Nolan, Magee, & Burt, 2004), which also
targets families with substantial prior homelessness (an average of four prior episodes and four years
homeless), families realized substantial subsequent residential stability, having lived in their current
supportive housing residences for an average of 2.2 years at the time of the evaluation.
Finally, the Charles and Helen Schwab Foundation Housing First Initiative was designed to rapidly house
and help maintain the stability of at-risk families who did not have a prior history of homelessness or
significant barriers to housing (including active substance abuse, recent domestic violence experience).
The evaluation of the initiative (LaFrance, 2005) found that 88 percent of the families targeted had been
successfully housed in Section 8 or market rate housing, and the time it took to become housed had been
significantly reduced. Year 1 outcomes indicated that only one family housed had lost the housing. This
program also provided housing search assistance, move-in and other financial assistance, and home-based
case management.
In sum, the evaluations to date of housing interventions all note improvements in housing stability, and
often improvements in other outcomes (e.g., income; child school attendance), for the families they serve.
However, without comparative information, we still lack knowledge of what level of housing and
assistance is needed by whom to acquire and remain in housing.
Ameliorating the Problems Homeless Families Face
The major examination of services for homeless families that has occurred since 1998 is the Center for
Mental Health Services (CMHS) and Center for Substance Abuse Treatment (CSAT) Homeless Families
Program, a five-year, two-phased, multisite study initiated in 1999 to advance knowledge about the
effectiveness of interventions for homeless mothers with psychiatric and/or substance abuse disorders
who are caring for their dependent children (Rog, Buckner al., in press). It was specifically designed to be
the first multisite evaluation of the effectiveness of innovative interventions, compared to services as
usual or alternative interventions, in addressing the particular treatment and service needs of homeless
families.
The focus of the target intervention in each site in the CMHS/CSAT Homeless Families Program was to
be a time-limited (i.e., no more than a nine-month period of intensive services) intervention aimed at
meeting the psychiatric, substance abuse, and/or trauma services needs of homeless women with children.
The interventions were to be existing programs in the community, but could be enhanced. All target
interventions were to be multifaceted, involving a combination of services focused on mental health
treatment, substance abuse treatment, trauma recovery, securing and maintaining housing, parenting
skills, household and money management, and goal setting.
Despite having a common set of core parameters, the target intervention models varied widely across the
eight sites. Most sites involved some form of “intensive case management,” but combined that approach
with other services in various settings. Three sites used more comprehensive service approaches,
including (1) a multidimensional family assistance intervention in which families were provided with
multisystemic therapy both in the shelter and in their residence (Henggeler et al., 1998), (2) multiple
services (i.e., family-centered case management, home-based parent support, education and skills
training, and child-focused interventions such as primary care) through a Comprehensive Family Health
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Practice within a community health center, and (3) a family therapeutic community in a residential
substance abuse treatment program that was enhanced with trauma recovery and aftercare components.
Results from the CMHS/CSAT initiative are currently being analyzed and reported. Overall, the study did
not find any effects of the target interventions on a range of outcomes for the homeless families compared
to services as usual (e.g., Pearson et al., in press; Rog, Buckner et al., in press; Sacks et al., in press).
However, for substance abuse and mental health outcomes, having more on-site services in these areas
was associated with greater improvements for all families, and especially for families with clinical-level
need for substance abuse and mental health services (Pearson et al., in press; Rog, Buckner et al., in press)
Homeless mothers in programs that provided more on-site mental health services, such as having a
psychiatrist or psychologist on site and having designated mental health providers who could provide an
array of mental health services in the shelter or other setting where the families resided (e.g., residential
treatment), experienced a greater decrease in their mental health symptoms than mothers who were in
programs that had fewer on-site services and/or relied on referral services. Similarly, homeless mothers in
programs with on-site substance abuse services reported less substance use over time than mothers in
programs with fewer on-site services.
In addition, because of the multisite study’s longitudinal design, it was possible to examine trajectories of
change over time and to examine the role of other time-varying conditions on families’ outcomes. On
most outcomes, families in both the target and comparison conditions on average had a positive rate of
change. However, for each outcome, there was a substantial segment of families who started with mental
health problems severe enough to warrant treatment and who did not show improvement over 15 months.
Across outcomes, reports of ongoing trauma and network conflict were associated with less improvement,
whereas employment was associated with more improvement (e.g., Pearson et al., in press; Rog, Buckner
et al., in press; Sacks et al., in press). These findings suggest the need for not only understanding the
history of problems families have as they enter shelter and other settings, but also the struggles they
continue to experience that may be interfering with their ability to progress.
Interventions Focused on Homeless Children
There continue to be a limited number of evaluations of interventions that target homeless children (or
their mothers) in an effort to improve their well-being. A few studies have evaluated school-based or
summer program interventions for homeless children (Nabors, Weist et al., 2004; Nabors, Sumajin et al.,
2004). More recently, Buckner et al. (in press), examined the effectiveness of multifaceted, motherfocused interventions on improving the behavior of children who participated in the eight-site
CMHS/CSAT Homeless Families Program Initiative. Data were collected at four time points (an initial
assessment followed by three similar assessments 3, 9, and 15 months later) on 1,103 children, ranging
from 2 to 16 years of age, who were living with their mothers. Hierarchical linear modeling was used to
examine whether intervention status, programmatic emphases, and other factors predicted rate of change
in behavior problems over time. While the results indicated that, overall, children’s problem behaviors
improved over time, neither treatment status (target intervention versus comparison intervention group)
nor programmatic emphases were associated with change in problem behaviors either within or across the
eight sites. Consistent with previous research, measures of the mother’s psychological distress as well as
parenting practices were found to be good independent predictors of child behavior problems. Results
from this study indicate that further research and program development are needed to identify effective
strategies for addressing the mental health and behavioral needs of homeless and low-income children.
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Preventing Homelessness
Targeting Families for Prevention
The importance of subsidies in reducing the risk of family homelessness among poor families strongly
suggests that increasing the amount and access to these benefits to such families would likely result in a
lower incidence rate of family homelessness. Policies to reduce the cost of housing, thereby making it
more affordable, are also important. Broad-based efforts to help families pay the cost of housing and to
lower such costs are needed to prevent family homelessness.
However, preventing family homelessness in a more targeted fashion by selecting low-income families
who are most at risk to be recipients of a preventive intervention remains difficult at this time. This is due
both to the difficulty of selecting families who have a very high risk of homelessness and the challenges
of ameliorating those risks enough to substantially lower the probability of their becoming homeless.
Trying to broadly identify families who are most vulnerable to homelessness—even among extremely
low-income people—may be inefficient. In the recent reanalysis of the Fragile Families study (Rog et al,
2007), a longitudinal study of a nationally representative birth cohort of new parents and their children,
we found that even among women who are extremely poor (at or below 50 percent of the poverty level),
the risk of being homeless is not as large as one might expect. Using a very broad definition of
homelessness, fewer than 1 in 10 (8 percent) of the women in this poverty sample indicated that they had
been homeless for even one night over a one- to three-year period. This number, however, is tempered by
the fact that attrition could account for greater difficulty in locating homeless families or families
experiencing residential instability at the time the interviews were being conducted. Despite at least 20
telephone or in-person attempts made with each eligible woman (Knab, personal communication), the
study lost 11 percent of their baseline sample at Year 1, and 14 percent in Year 3, with only 6 percent
missing both follow-ups. Approximately half of the missing cases were due to women refusing to be
interviewed, being too ill to be interviewed, being incarcerated and unavailable to be interviewed, or
being no longer eligible to be interviewed (e.g., parent or focus child was now deceased), while the rest
were missing because they could not be located or had moved out of state 1 . If the assumption is made
that the group of respondents who could not be located were all homeless, the upper bound for the
percentage of women homeless increases to 23 percent for those who are in the poverty sample (Rog and
Holupka, unpublished). Attrition analyses also indicated that among the factors that were significant
predictors of missing data, several factors, including greater likelihood of reporting baseline substance use
and domestic violence and less likelihood of receipt of TANF and/or Food Stamps at baseline, may
suggest some level of vulnerability among those missing in Year 3 to being homeless. There are other
factors, however, such as one site having greater attrition, that may have more to do with methodology
and less with the personal characteristics of the individuals. Even with this upper bound of homelessness,
however, fewer than one in four families living at 50 percent of the poverty level or less would be
expected to experience homelessness within a three year period.
Similarly, Shinn and colleagues (1998), in their New York City study, needed 20 predictors to distinguish
new applicants for shelter from the public assistance caseload in 1988. They were able to build a model
1
For the Year 1 interview, 50 percent of the missing interviews were due to problems locating the respondent; in
Year 3, 56 percent were missing for these reasons.
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that correctly identified 66 percent of shelter entrants while targeting 10 percent of the public assistance
caseload. With a large public assistance caseload, however, even 10 percent misidentified as needing
services means that four families who would not become homeless would be identified for every family
who would receive homeless services; thus 80 percent of services would be wasted. In addition, any
model based on a single risk factor would do more poorly and a complicated model such as the one used
by Shinn and her associates would be impractical.
Bassuk, Weinreb, Dawson, Perloff, & Buckner (1997), in their multivariate analyses of risk and
protective factors that distinguished homeless from low-income housed families, also relied on a number
of different variables. Their findings indicate that there are multiple sources of risk for family
homelessness (in the realms of mental health, substance use, social supports, housing history and lack of
subsidies) and that there is no one standout risk factor that, if ameliorated, would substantially lower the
incidence rate of family homelessness.
Thus, targeting families based on their needs, such as domestic violence, mental health, and substance
abuse, is likely not to be fruitful given the equally high rates for low-income families generally. In
addition, none of these factors predicted shelter entry in New York, when other factors, primarily
demographic characteristics and housing histories, were taken into account (Shinn et al., 1998).
Based on the research to date, two groups of families that may be at highest risk are young families and
those who have experienced shelter in the past. As noted earlier, studies have consistently shown that
homeless families are younger than other low-income families (Shinn & Weitzman, 1996). One
possibility of identifying families at risk is to assess the housing assistance needs of pregnant women and
mothers of newborns using health clinics serving low-income families. Housing loans and assistance to
pregnant and new mothers, such as through WIC (the Women, Infant, and Children Food and Nutrition
Information Program) and subsidized child care might help reduce burdens that contribute to financial
problems that can lead to homelessness.
In addition, there is a small subgroup of families who return to shelter, even after receiving subsidized
housing. In New York, families who left subsidized housing to return to shelter did so primarily because
of serious building problems or safety issues (rats, fire or other disaster, condemnation, or the building's
failure to pass the Section 8 inspection) (Stajonovic et al., 1999). Thus, efforts to assure the quality of
housing to which families go might lower shelter return rates. Finally, poor families with many competing
financial pressures may benefit from subsidies paid directly to landlords, to aid in making housing the
first priority.
Another approach to preventing homelessness is to select families on the basis of the neighborhoods in
which they live. In Philadelphia and New York, between three-fifths and two-thirds of families entering
shelter over an extended period came from identifiable clusters of census tracts (Culhane, Lee, &
Wachter, 1996). Geographic-based prevention could include a range of environmental- and individualfocused efforts, including housing construction or rehabilitation, job development and training, child care
that permits mothers to take jobs, substance abuse treatment, and so forth.
Community-Wide Prevention
To learn about effective prevention strategies, the U.S. Department of Housing and Urban Development
funded a study to identify communities that have implemented communitywide prevention strategies with
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documented effectiveness and to describe and review these strategies and the supporting data (Burt,
Pearson, & Montgomery, 2005). Six communities were ultimately selected, three for their primary
prevention strategies for families: Hennipen County, Minnesota; Montgomery County, Maryland; and
five counties in the Kansas City metropolitan area. These three communities targeted families with shortterm problems that could be resolved with the resources they had available. Communities offered cash
assistance to prevent eviction and pay back rent, utilities, and mortgage, as well as other in-kind
assistance and counseling. Other strategies used included mediation services, which help families resolve
conflict with various parties; rapid exit strategies, which get families into housing first (or exiting shelters
quickly); and programs that use data and research to target families at highest risk of entering shelter for
special outreach and assistance (Burt, Pearson, & Montgomery, 2005). The authors also note that there is
ample evidence for housing subsidies as a prevention strategy from other studies, though not in their sixcommunity review.
Overall, the study concluded that the most effective prevention efforts were in communitywide systems
having elements that affect their ability to target families well (e.g., systems for sharing data); reflect the
community motivation and obligation to serve this population; maximize resources, such as agency
collaboration; and demonstrate community leadership in setting future direction. Of the three
communities studied, Hennepin County was found to have most of the elements and thus had the best
potential to prevent homelessness and document its success.
Recommendations for Future Research
Research on Homeless Families
Broader geographic samples. The research base on homeless families has grown over the last decade,
but there continue to be significant gaps in knowledge that, if addressed, could bolster our understanding
of the needs of families and strategies for preventing and reducing homelessness. One of the limitations of
the current research base is that most of the rigorous studies are in selected cities across the country and
several are targeted to specific subgroups of families, often those with heightened needs. Thus, there is a
need for information on homeless families from broader geographic areas, especially in the Midwest and
South and in rural areas. There is also an absence of research on key population groups, including
families at risk for homelessness; moderate-need families; families who fall back into homelessness after
receiving interventions; families who are working but continue to be homeless; two-parent families;
families headed by a single father; families living in extended family networks; and single homeless
adults who are noncustodial parents.
Longitudinal designs. Most studies to date, with a few recent exceptions, have had cross-sectional
designs. Longitudinal studies are needed to explore the course of residential instability and homelessness
over several years, and the individual, contextual, and intervention factors that influence this course.
Longitudinal research of at-risk families would also help to differentiate distal risk factors for
homelessness from proximal, mediating variables, which serve as risk and protective factors for family
homelessness.
Research on housing affordability strategies. The core importance of housing affordability in
mitigating homelessness among families and children calls for research on broad-scale housing and
income policy interventions. For example, among the interventions that could be studied for effects on
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rates of homelessness are varying amounts of housing subsidies; tying income supplements to housing
vouchers; and any other mechanisms for increasing incomes and reducing housing costs for young
families.
Intervention research. Finally, there is still a large need for research on the match between housing
approaches and the needs of families. In particular, there is a need for rigorous data on the role of services
in ameliorating the range of health, mental health, child welfare, substance abuse, and other service needs
that families may have, especially in the context of providing housing. How much service is needed and
by whom? The evaluations to date provide evidence that most tested housing approaches result in
increases in housing stability, but there are no studies to date that offer comparative information on
different housing and service models. These data are critical to understanding which families need what
level of intervention to acquire and keep housing as well as to make strides in other outcome areas (e.g.,
employment).
The findings from the CMHS/CSAT Homeless Families Project indicate the challenges of devising
effective interventions to address the mental health, substance abuse, and housing stability issues of
mothers who are homeless (Rog, Buckner, & the CMHS/CSAT Homeless Families Program Steering
Committee, in press). Additional intervention development work is needed to learn effective strategies
that benefit homeless families in these realms.
Research on Children Who Are Homeless
Understanding the specific homeless experience and its impact. Research conducted to date on
children who are homeless has illuminated a fair amount of knowledge on current needs and the impact of
homelessness. It would be desirable for future research to address aspects of the homelessness experience
that are particularly detrimental to children (Buckner, 2004b). This could help refine the question from
whether homelessness has an effect to what aspects of homelessness are prone to creating problems in
what age groups and in what domains. Shelter conditions are probably an especially important factor in
moderating the impact of homelessness for a child and research is needed in this area. No doubt, this
would be a challenging task and most previous studies have likely not encountered sufficient variability in
shelter conditions to examine such issues. Nonetheless, it stands to reason that there are important
qualities of shelters that may worsen or buffer a child’s experience while living there. These could include
the amount of privacy accorded to families, the crowdedness of the facility, the extent to which rules are
strictly enforced, the warmth and skill level of shelter staff, the size of the facility, its location, and
whether families are asked to leave during the day or may remain on the premises.
In addition, it would be useful to clarify the relative impact that homelessness can have on children in
relation to a wider range of negative life events and chronic strains that children living in poverty
experience. This would be helpful in better targeting treatment resources and preventive efforts to those
low-income children (homeless and housed) most in need.
Research on subgroups of children who are homeless. Likewise, further research on whether there
are special subgroups of homeless children with needs would help to determine whether it makes sense to
more narrowly target intervention and treatment resources to select children living in shelters. Most of the
research to date on children who are homeless has taken a variable-centered approach to analyses,
focusing on specific areas such as mental health, behavior, and academic performance. Little if any
attention has been paid to whether there are subgroups of children with quite different patterns of
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functioning across these areas of domains. One study that did employ a person-centered approach
(Huntington, Buckner, & Bassuk, in press) used cluster analysis to determine whether preschool and
school-age homeless children could be classified into subgroups based on measures of behavior problems,
adaptive functioning, and achievement. Interestingly, two very distinct subgroups were found within each
age category: children who were doing reasonably well across each of the three domains (behavior,
adaptive functioning, and achievement), and children who were consistently evidencing worse problems
or lower functioning in these realms. These results warrant replication in other settings but suggest that
children who are homeless, when compared across indices of functioning, are not a homogenous group.
Intervention research. Very little progress has been made in determining effective interventions that
specifically target children who are homeless. Evaluations of the impact on children of interventions that
primarily focus on the mother as the recipient of services have yet to yield promising leads. If homeless
children are to benefit, it is likely that more child-centric intervention strategies will need to be developed
and tested.
Parent-child separation. Parent-child separation is an important area that needs further research. The
factors that account for child separation from families prior to shelter entrance need to be better
delineated. Also, the effects of such separation on children have yet to be investigated. Mostly due to
logistical reasons, research on homeless children to date has focused entirely on children who remain with
their parent(s) and have not included children who have been separated.
Resilience. It is also worthwhile to understand factors both internal and external to a child that lead to
positive outcomes despite the adversities of poverty. Such findings lend themselves to more strengthsbased interventions that attempt to promote positive factors as opposed to trying only to eliminate risk
factors. Buckner, Mezzacappa, and Beardslee (2003) found two characteristics of homeless and lowincome children in Worcester that distinguished those who were resilient from those who were not doing
nearly as well on multiple indicators of mental health and adaptive functioning. One of these factors was
parental monitoring. A child whose parent(s) engaged in active awareness of where and with whom their
child was on a daily basis tended to exhibit more resilience. Another, even more important, variable
distinguishing resilient from non-resilient children was an internal set of cognitive and emotional
regulation skills that researchers refer to as “self-regulation” (Baumeister & Vohs, 2004). Self-regulation
helps an individual accomplish both short and longer term goals and can be important in coping
effectively with stress. In the WFRP, children high in self-regulation looked much better across measures
of mental health, behavior, adaptive functioning, and academic achievement than children low in selfregulation (Buckner, Mezzacappa, & Beardslee, n.d.). Furthermore, those high in self-regulation appeared
to be better able to cope with stressors in their lives. Variables such as parental monitoring and selfregulation offer promising leads for strengths-based interventions to promote resilience in homeless and
other low-income children.
Conclusion
This paper provides a summary of the literature on the risk factors and characteristics of homeless
families and children as well as a synopsis of what has been learned through tested interventions to reduce
homelessness, ameliorate its conditions, or prevent its occurrence. The paper highlights the implications
of what has been learned for future prevention, intervention, and research efforts.
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Overall, research to date has guided us in understanding the factors that heighten a family’s vulnerability
to homelessness—largely resources and life stage—and the problems faced by families who experience
homelessness. Although certain problems, such as family separations, are greater for homeless families,
most of the struggles experienced by homeless families are also experienced by families who are equally
poor but remained domiciled. Similarly for children, studies involving both homeless and low-income
housed children have consistently uncovered evidence for a “poverty-related” impact on children, that is,
finding that both groups have more problem measures compared to children from non-poverty
backgrounds. As such, homelessness serves as an important marker of risk for children. Detecting an
additional, homelessness-specific, impact in different realms of child functioning has been more difficult.
What we know about intervening is that subsidies have a strong role in reducing homelessness and
helping to end it for families who receive them. There has been much less research on strategies for
dealing with risk factors or the struggles families cope with on a day-to-day basis. We need to know more
about the housing and services that are needed to match the “typology” of families that exist. It may be
most advantageous to develop interventions from the “ground up,” examining the needs that families have
and understanding the possibilities and constraints in the context of implementing different interventions.
This may involve developing a theory of intervention based on what we know about the problems
families are experiencing and the realities of what is available or can be made available. Clearly, targeting
those most in need of services may be the most efficient and worthwhile approach to addressing
psychosocial and substance abuse issues. Data collected thus far suggest that most families may improve
over time with limited intervention, but there may be a subset of families living in shelters that require
much more intensive interventions than are readily accessible.
The low incidence of homelessness even among those who have limited financial means suggests that
there is more efficiency in mounting secondary, versus primary, prevention efforts targeted to families at
imminent risk of homelessness. Strategies underway that warrant further study include conflict mediation,
financial assistance strategies, and other context-specific strategies. This is not to rule out other
prevention efforts, as it is clear that many families are living on the edge and precariously housed, but to
acknowledge that prevention of imminent homelessness is likely best focused on those who request
shelter.
Finally, more research is needed on the course of homelessness and its effects on families, especially on
children. These studies need to strive to focus on broader populations of families (i.e., not just those with
specified needs) to provide a greater understanding of the needs of various segments of the population and
how they may be best met.
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5- Homeless Families and Children Abstract

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